We propose to use existing proprietary and public data sources and geospatial methods to determine how the geographic accessibility of pharmacies impacts place-based disparities in adherence to cardiovascular medications among older adults in the U.S. This issue is at the forefront of older adult minority health and health policy, considering the health and survival benefits of cardiovascular medications and recent expansion of older adult prescription drug coverage has failed to reduce disparities in adherence to prescription medications. Further, several national studies indicate that disparities in adherence are not due to individual differences in income, education or health insurance, and suggest older adult minorities may encounter barriers in adhering to prescription medications not experienced by their White counterparts, including the accessibility of pharmacies. Our preliminary analyses suggest substantial place-based disparities in both pharmacy density and adherence to both statins and ?locker. For the proposed study, we will leverage geocoded longitudinal patient-level pharmacy claims data for more 50 million Americans, and information on pharmacy locations, in the United States to conduct an observational cohort study to examine how the geographic accessibility of pharmacies or pharmacy density impacts disparities in adherence to commonly used cardiovascular medications, including statins and blockers, among adults 65 years and older in the U.S. We will also examine the role of individual- (e.g. age, poly-pharmacy) and community-level (e.g. poverty, vehicle ownership) factors often associated with adherence. Finally, we will apply geospatial methods using patient-level adherence aggregated at the community-level to identify older adult minority communities most at-risk for low-adherence. Our proposed work is innovative because it will be the first study to incorporate geospatial methods in analyses of disparities in medication adherence at older ages. Our data will also allow for unprecedented granularity in examining individual and community-level factors that influence disparities in adherence at national and local levels. Our focus on the role of the geographic accessibility of pharmacies is novel considering pharmacies are an increasingly important, yet often overlooked, component of U.S. health care delivery in the older adult population. With respect to expected outcomes, the work proposed is expected to contribute new knowledge which policymakers, practitioners and researchers need to develop innovative policies and programs to improve disparities in medication adherence among older adults. This is particularly important given a growing segment of the minority population is publicly insured and Centers for Medicare/Medicaid Services has endorsed quality measures that include adherence to cardiovascular medications that have yet to be examined in the context of disparities. These outcomes are expected to have a positive impact, as pharmacies will only grow in importance and relevance to health disparities as their scope of services continues to expand to include preventative care.